Remote Utilization Review Rn Jobs in Decatur, GA

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The Registered Nurse Clinical Annotator plays a critical role in supporting the development of artificial intelligence models designed to streamline and automate prior authorization processes in healthcare. This position leverages clinical expertise to interpret, annotate, and validate medical documentation, ensuring that AI systems are trained on accurate, contextually relevant, and policy-compliant data.

General Job Profile

• Reviews the work of others
• Develops innovative approaches
• Sought out as expert
• Serves as a leader/ mentor

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Review medical records and interpret clinical documentation with accuracy and clinical judgment
• Apply guideline based criteria to annotate, categorize, and label case data used for AI model training
• Ensure annotations are clinically sound, consistent, and aligned with established utilization management (UM) guidelines
• Contribute to the development of high quality training datasets that support safe and effective AI model performance
• Identify gaps, ambiguities, or inconsistencies in documentation and escalate issues as needed
• Participate in refinement and continuous improvement of annotation guidelines, clinical rules, and workflows
• Collaborate with cross functional teams including data science, clinical operations, and product teams to ensure clinical accuracy and operational relevance of labeled data
• Support testing, validation, and quality review activities for AI supported UM tools and workflows
• Maintain detailed documentation of annotation decisions, rationales, and guideline interpretations
• Uphold clinical, ethical, and regulatory standards in all aspects of data handling, patient information, and annotation workflows

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Active, unrestricted RN license
• 3 years of recent clinical experience in acute care, case management, utilization management, or a related clinical specialty
• Solid understanding of clinical documentation, medical terminology, and evidence based practice
• Experience applying guideline based criteria (e.g., InterQual, MCG) in clinical review or UM workflows
• Ability to interpret medical records and determine clinical appropriateness using structured criteria
• Proficiency with electronic medical records (EMR) and comfort navigating multiple clinical systems
• Familiarity with HIPAA requirements, data privacy standards, and safe handling of patient information
• Demonstrated experience performing clinical prior authorization reviews across diverse service categories, including medical/surgical procedures, diagnostic imaging, DME and related supplies, specialty therapies/devices, and other utilization management areas aligned to health plan medical policy

• Ability to work independently while maintaining productivity, quality, and adherence to annotation guidelines

Preferred Qualifications:

• BSN
• Experience collaborating with cross functional teams (clinical, data science, operations)
• Experience with data labeling, clinical data annotation, or AI/ML workflows
• High level of accuracy, attention to detail, and commitment to consistent, high quality annotations
• Solid analytical thinking, clinical reasoning, and ability to identify gaps or inconsistencies in documentation
• Effective written communication skills, with the ability to clearly document annotation decisions and rationales
• Curiosity and willingness to learn emerging technologies, AI supported workflows, and evolving guidelines

Values Based Competencies Employee

• Integrity Value: Act Ethically
  • Comply with Applicable Laws, Regulations and Policies
  • Demonstrate Integrity
• Compassion Value: Focus on Customers
  • Identify and Exceed Customer Expectations
  • Improve the Customer Experience
• Relationships Value: Act as a Team Player
  • Collaborate with Others
  • Demonstrate Diversity Awareness
  • Learn and Develop
• Relationships Value: Communicate Effectively
  • Influence Others
  • Listen Actively
  • Speak and Write Clearly
• Innovation Value: Support Change and Innovation
  • Contribute Innovative Ideas
  • Work Effectively in a Changing Environment
• Performance Value: Make Fact-Based Decisions
  • Apply Business Knowledge
  • Use Sound Judgement
• Performance Value: Deliver Quality Results
  • Drive for Results
  • Manage Time Effectively
  • Produce High-Quality Work

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.